THE ENDOGENOUS INTOXICATION SYNDROME AND
HEMODYNAMIC SHIFTS DURING THE TREATMENT
Pavlinova
V.V., Voityka 25-32, Stavropol 355008, Russia
Objectives: The aim of this study
was to evaluate the severity of hemodynamic shifts in patients with
different degrees of endogenous intoxication syndrome and determine the
possibility of using this data for prognosis of disease severity and
treatment efficiency.
Methods: 109 patients, age 20-75
years, men 54% and women 46%, suffering from surgical diseases, complicated
with endogenous intoxication syndrome. According to the laboratory and
clinical data all the patients were divided into 3 groups: group A
– 22 patients with endogenous intoxication syndrome of 1 degree,
group B – 32 patients with endogenous intoxication syndrome of 2
degree and group C – 55 patients with endogenous intoxication
syndrome of 3 degree. Control group consists of 25 healthy persons, age
20-76 years, men 48%, and women 52%, who were selected randomly. Clinical
data (cardiac output (CO), mean arterial blood pressure (mean ABP), common
peripheral vessels resistance (CPVR)) were measured using non-invasive
method at 1, 3, 5 and 9 day of treatment.
Results: At 1 day of treatment the mean data
in-group A were not statistically differs from the same measured data in
control group. In-group B at the same time CO and CPVR were higher then in
control group and were at levels 4202,7+ 269,7 ml and 2828,3+144,2 din穝-1穋m-5. The mean
ABP was lower control data: 84,6+2,5 mm. Hg (p<0,01). During the active
treatment at 5 and 9 days of therapy all the data decreased and
don’t differs statistically from control group.
The most
interesting results were found in-group C – patients with
endogenous intoxication of 3 degree. In those patients, who still alive, at
1 day CO was much more higher then in control group and in groups A, B. The
mean level was 5920,1+319,4 ml (p<0,005). At the same time mean ABP at
level 71,8+2,6 mm. Hg. and CPVR at level 1313,4+202,6 din穝-1穋m-5 were lower
control data (p<0,005). During intensive therapy at 5 day CO and CPVR
decreased and mean ABP increased but statistically unclear. At the 9th day
of therapy mean ABP and CO became closer to control group measurements, but
CPVR at the same time was higher control data and was at level 2291,5+191,6
din穝-1穋m-5 (p<0,01).
In those
patients of group C, who died during the treatment, at the 1 day CPVR and
mean ABP were extremely lower than in control group, groups A, B and alive
patients of group C: mean ABP at level 64,7+4,5 mm Hg and CPVR at level
833,5+114,1 din穝-1穋m-5. It was found, that
cardiac output in this group of patients was extremely increased in
comparison with all the other groups: 6101,6+571,9 ml. After intensive care
condition of patients was not improved, and at 3-day progressive decreasing
of mean ABP – 35,5+16,4 mm Hg and CPVR – 158,8+47,2 din穝-1穋m-5 was
detected. Cardiac output at the same time increased and its level was
8445,9+2625,4 ml.
CONCLUSION:
during the trial was found that in patients of group A hemodynamic is not
differs from healthy persons. In-group B at 1 day we can see increased mean
ABP and decreased CO and CPVR, but all data became normal at 5 day of
treatment. In group of died patients with endogenous intoxication syndrome
of 3 degree (group C) at 1 day CPVR and mean ABP were lower than in all
other groups and extremely lower control data (CPVR 2 times and mean ABP
2,5 times lower). More over, after treatment was found progressive
decreasing of them at 3d day. CO was increased all the time. Using this
data together with laboratory data we can suppose, that extremely lowered
mean ABP and CPVR (more than 2 times in comparison with normal data) at 1
day of treatment and absence of positive dynamic during 3 days can be
determined as bad prognosis for patient’s life.